Provider Demographics
NPI:1225585847
Name:MACKEY, PAULA SHANTEL ALEXIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:SHANTEL ALEXIS
Last Name:MACKEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SHANTEL
Other - Middle Name:
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:3309 HAYNES AVE.
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707
Mailing Address - Country:US
Mailing Address - Phone:512-535-8433
Mailing Address - Fax:432-242-0982
Practice Address - Street 1:3309 HAYNES AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3600
Practice Address - Country:US
Practice Address - Phone:512-535-8433
Practice Address - Fax:432-242-0982
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical